Understanding Asthma Treatments – Relievers and Preventers

Millions of people around the world suffer from Asthma, a chronic lung condition characterized by difficulty in breathing. During an asthma attack, the sufferer’s airways become irritated and react by narrowing and constructing. That causes increased resistance to airflow, and obstructs the flow of the air to and from the lungs.

How is asthma treated?Asthma is treated using two main types of medicines:

• Quick Relief Treatments: also called relievers. These give rapid, short-term treatment and are taken when you have worsening asthma symptoms that, left untreated, can lead to asthma episodes or attacks. You will feel the effects of these medicines within minutes.
• Long-Term Control Treatments: also called preventers, and are for people with persistent asthma, who need long-term control medicines. Preventers are taken every day, usually over long periods of time, to control chronic (long-term) symptoms and to prevent asthma episodes or attacks. You will feel the full effects of these medicines after taking them for a few weeks.

Drugs related to hormonesDrugs, such as those resembling two of our hormones, can help treat asthma. These two hormones are epinephrine (adrenaline in the UK) and hydrocortisone (a steroid). Epinephrine is pumped into our bloodstream when we have a sudden fright or emergency – psychologists often call this state fright or flight. Epinephrine is the quick-acting hormone from the middle of the adrenal glands near our kidneys. It makes your pulse race, your heart thump, and readies your body for emergency action. In asthma, the medicines which resemble adrenaline quickly relieve asthma for a short time, and are from the reliever family.

Hydrocortisone comes from the outer part of our adrenal glands, called the 'cortex'. It is also partly an “emergency hormone” but it works much more slowly, for much longer, and in a completely different way to adrenaline. Medicines which resemble hydrocortisone slowly allow the lining of air tubes in an asthma sufferer to become normal. As a result, your asthma becomes less severe and you are less likely to get asthma attacks. So these steroid medicines are part of the preventer family. Steroids are the most powerful preventers currently available.

Other long-term treatments include:

• Long-acting beta-agonists are bronchodilators, not anti-inflammatory drugs. These medicines are used to help control moderate and severe asthma and to prevent night-time symptoms. Long-acting beta-agonists are taken together with inhaled corticosteroids 
• Leukotriene modifiers (such as montelukast, zafirlukast, and zileuton) are long-term control medicines used either alone to treat mild persistent asthma or together with inhaled corticosteroids to treat moderate persistent asthma or severe persistent asthma. 
• Cromolyn and nedocromil are used to treat mild persistent asthma. 
• Theophylline is used either alone to treat mild persistent asthma or together with inhaled corticosteroids to treat moderate persistent asthma. People who take theophylline should have their blood levels checked to be sure the dose is appropriate.

Be careful. If you stop taking long-term control medicines, your asthma will likely worsen again.

Taking preventersInhaled corticosteroids (or steroids for short) are the preferred treatment for controlling mild, moderate, and severe persistent asthma. They are safe when taken as directed by your doctor.

Inhaled medicines go directly into your lungs where they are needed. There are many kinds of inhalers that require different techniques, and it is important to know how to use your inhaler correctly.

Usually the best way to take these medicines is to breathe them in. That is, you inhale them, through your nose or mouth. The reasons you inhale them are:

• because you need less of the medicine, 
• you won't suffer as many side effects, and, 
• the medicine works more quickly,

The final point is particularly important with the adrenaline-like, fast-acting relievers.

Another advantage is that the hydrocortisone-like steroid preventers you breathe in can be chosen to be biodegradable inside the body. As a result, then can do their work in the lung, but don't get much of a chance to produce any side effects in the rest of your body, because your liver breaks them down.

In some cases, steroid tablets or liquid are used for short times to bring asthma under control. The tablet or liquid form may also be used to control severe asthma.

Taking quick relief medicinesQuick relief medicines are used only when needed. A type of quick relief medicine is a short-acting inhaled bronchodilator. Bronchodilators work by relaxing the muscles that have tightened around the airways. They help open up airways quickly and ease breathing. They are sometimes called "rescue" or "relief" medicines because they can stop an asthma attack very quickly.

These medicines act quickly but their effects only last for a short period of time. You should take quick relief medicines when you first begin to feel asthma symptoms like coughing, wheezing, chest tightness, or shortness of breath. Anyone who has asthma should always carry one of these inhalers in case of an attack. For severe attacks, your doctor may also use steroids to treat the inflammation.

Work closely with your doctorMany people with asthma need both a short-acting bronchodilator to use when symptoms worsen and long-term daily asthma control medication to treat the ongoing inflammation. Over time, your doctor may need to make changes in your asthma medication. You may need to increase your dose, lower your dose, or try a combination of medications. Be sure to work with your doctor to find the best treatment for your asthma. The goal is to use the least amount of medicine necessary to control your asthma.